tbuckley/cabot-search huggingface dataset:
Abstract 12786: Contemporary Outpatient Management of Patients With and Without Worsening Heart Failure With Reduced Ejection Fraction Within A Single Integrated System: Results From Electronic Medical Record Data in the CHART-HF Study
Authors: Hanna K Gaggin, Stephen J Greene, Mo Zhou, Dominik Lautsch, Yan Song, James Signorovitch, Andra S Stevenson, Robert Blaustein, Javed Butler
Journal: Circulation (2022)

Background: Patients with HFrEF and worsening HF events (WHFE) have substantial disease burden and poor outcomes. CHART-HF aims to characterize real-world clinical characteristics, longitudinal treatment use, and therapeutic decision-making among patients with HFrEF with vs without WHFE. Methods: Retrospective analysis of EMR data of 1000 adult patients with HF (with LVEF &lt;45%) from a single integrated health system with 2 mutually exclusive cohorts was conducted. The WHFE cohort included patients with a WHFE (i.e., hospitalization or receipt of IV diuretics) between 2017-2019 followed by an index outpatient cardiology visit ≤6 months. The control cohort included patients with no WHFE in a given year between 2017-2019. Index visit was defined as the last outpatient cardiology visit in the given year. Treatment use followed for 12 months. Results: Patients with WHFE were slightly older (68.6 vs. 68.0 years), had more females (28.8 vs. 24.4%) and had more comorbidities such as hypertension, atrial fibrillation, COPD, diabetes mellitus and chronic kidney disease compared with control patients (p&gt;0.05). On index date, 81% of WHFE cohort patients were on beta blocker (BB), 55% on ACEI/ARB/ARNI, and 18% on MRA ( Figure, Panel A ) while 75%, 66%, and 22%, respectively, in the control cohort ( Figure, Panel B ). In both the WHFE and control cohorts, use of BB and ACEI/ARB/ARNI decreased while patients without any GDMT increased in the 12 months. The most frequent reason for not changing GDMT was “clinically stable and/or adequate symptom control” ( Figure, Panel C ). The median time to next HF hospitalization or death was 30 and 136 weeks from index date in WHFE and control cohort, respectively (p&lt;0.001). Conclusion: Among US patients with HFrEF, there remain major gaps in use of GDMT and these gaps persist during longitudinal outpatient follow-up. These longitudinal gaps in GDMT are particularly large among the high-risk subset of patients with a recent WHFE.
Abstract 14292: Association of Technetium Pyrophosphate Scan Grade With Adverse Remodeling and Burden in Cardiac Amyloidosis
Authors: Seth Scheetz, Nazia Alvi, Karolina Zareba, Patel Amit, Akash Goyal, Cristiane de Carhalho Singulane, Nitasha Sarswat, Karima Addetia, Ajay Vallakati, Jeremy Slivnick
Journal: Circulation (2022)

Introduction: While technetium pyrophosphate (Tc-PyP) is known to be highly accurate for identifying transthyretin cardiac amyloidosis (ATTR-CA), it is currently unclear whether the grade of uptake observed on Tc-PyP correlates with either amyloid burden or adverse cardiac remodeling. Methods: At three academic medical centers, we retrospectively identified patients with confirmed ATTR-CA—defined in accordance with guidelines using either tissue biopsy or grade ≥2 Tc-PyP uptake—who underwent Tc-PyP and cardiac magnetic resonance (CMR) at 1.5T (Phillips, Siemens or GE). Left (LV) and right (RV) ventricular size, mass, and systolic function were quantified. T1 mapping including extracellular volume (ECV)—a surrogate for amyloid burden—was quantified according to guidelines. 3-hour Tc-PyP grade was assessed in accordance with guidelines. CMR markers were correlated with Tc-PyP grade using ANOVA with pair-wise comparisons made using t-test, Wilcoxon rank, or chi-squared as appropriate with p&lt;0.01 used to denote significance. Results: 45 patients were included (mean age 75.4 years, 75.6% male). Within the cohort, grade 0, 1, 2, and 3 uptake were present in 1(2%), 3(7%), 6(13%), and 35(78%) patients respectively. All patients with Tc-PyP grade &lt;2 were confirmed to have ATTR-CA by endomyocardial biopsy. Neither age, gender, or comorbidities differed significantly based on Tc-PyP uptake (Panel A). In univariate analysis, both indexed LV mass and ECV were significantly associated with Tc-PyP grade (Panel B). As compared to those with grade 2, patients with grade 3 Tc-PyP uptake had significantly higher ECV (p&lt;0.001) and indexed LV mass (p=0.003). Conclusions: The presence of higher Tc-PyP grade is associated with increasing amyloid burden and a greater degree of adverse LV remodeling. Higher Tc-PyP grade appears to be indicative of more advanced disease stage in this patient population.
Abstract 13216: Evaluation of Left Ventricular Flow Propagation Velocity From Multi-Dimensional Cardiac Imaging
Authors: Jiacheng Zhang, Brett Meyers, Melissa Brindise, Yue-Hin Loke, Pavlos Vlachos
Journal: Circulation (2022)

Introduction: The propagation velocity (Vp) during the left ventricular (LV) early diastole has been proposed as a marker of the diastolic function. However, the measurement of Vp is limited to one-dimensional data from Color M-mode (CMM) echocardiography and does not consider the spatiotemporal variation of Vp. Methods: We introduce a new method to evaluate the LV diastolic flow propagation from multi-dimensional cardiac flow imaging. The proposed method estimates the local and instantaneous flow propagation velocity (V prop ) by fitting the first order wave equation to the velocity gradients with weighted least-squares. The proposed method was validated using the synthetic vortex ring flow data. The method was applied to the LV flow data acquired with two-dimensional phase-contrast magnetic resonance imaging (pc-MRI) and 4D flow MRI. Results: The V prop estimated from multi-dimensional data has about 50% less error than the V prop from one-dimensional data. Fig. 1(a) shows the waveforms of the mitral inflow velocity, the IVPD, and the propagation intensity (I prop ) during the LV diastole of a normal filling patient. During early diastole, the timing of peak flow propagation coincides with the peak intraventricular pressure difference. Fig. 1(b) presents the fields of the blood flow velocity, the V prop , and the relative pressure from the timeframes indicated using the dotted lines in the waveform plots. The flow propagation towards the apex is mainly located at the front of the inflow jet and downstream of the vortex ring formed near mitral valve tips. Conclusions: This study introduces a novel propagation velocity measurement method for multi-dimensional cardiac flow imaging and demonstrated the V prop ’s spatial distribution temporal evolution.
Abstract 12820: Utilization of Cardiac Magnetic Resonance Imaging for Management of Coronary Chronic Total Occlusions
Authors: Caitlin S Drescher, Anna Lisa Chamis, Harsh Patolia, John Tanaka, Manasi Tannu, Islam Othman, William S Jones, Jennifer A Rymer
Journal: Circulation (2022)

Introduction: Revascularization of coronary chronic total occlusions (CTOs) may be indicated for relief of medically refractory angina. Myocardial viability assessment by cardiac magnetic resonance (CMR) may help select patients for CTO intervention. Real-world practice is not well described. Methods: We identified patients who underwent coronary angiography between 2016-2020 at a large tertiary center and had ≥1 CTO. Patients with prior CABG were excluded. We examined rates of CMR and outcomes including revascularization and MACE. Myocardial segments were attributed to a CTO territory and adjudicated following angiographic review of coronary anatomy. Significant CMR viability was defined as &lt;50% transmural delayed enhancement in the CTO territory. Results: We identified 1279 patients (74.1% male, 28.1% Black) who met inclusion criteria. Of these, 36.0% had type 2 diabetes mellitus and 54.9% reported angina pectoris. Over half of patients had CTO of the RCA (56.5%), and 18.5% of patients had CTO in &gt;1 vessel. Non-invasive testing was performed in 38.4% of patients; 10.8% had CMR. Rates of CMR were higher in patients with severely reduced EF (≤35%) compared to those with normal EF (≥55%) (22.1% vs 11.1%; p&lt;0.001). Among those who had CMR, 84.8% of patients showed significant viability in the CTO territory (Fig). CTO PCI was performed in 12.5% of patients, CABG was performed in 24.9%, and 63.2% were managed medically. Patients who had CTO PCI had higher rates of angina versus those without CTO PCI (70.0% vs 52.8%; p&lt;0.001) and were more likely to be on ≥2 anti-anginal medications (30.6% vs 18.9%; p&lt;0.001). CTO PCI technical success was achieved in 69.5% of patients and MACE occurred in 2.3% of cases. Conclusions: Patients with coronary CTOs demonstrate high rates of viability in CTO territories based on CMR. Rates of viability testing and CTO revascularization remain low. Further work is needed to determine the role of CMR and other non-invasive testing in CTO management.
Abstract 13213: Performance of a Modified RAISE Score to Screen for Cardiac Amyloidosis in Patients Undergoing Transcatheter Aortic Valve Implantation
Authors: Anne-Sophie Zenses, Stephanie Bechard, Valérie Fontaine, Mohamad J Mansour, Emilie Remillard, Zoe Carrier, Jessica Forcillo, Jean-Bernard Masson, Jeannot Potvin, Jean-François Gobeil, Daniel Juneau, Paula A Ribeiro, Stefania Argentin, Francois Tournoux
Journal: Circulation (2022)

Background: A high prevalence of cardiac amyloidosis (CA) can be found in specific populations such as TAVI [transcatheter aortic valve implantation] referrals. However, CA diagnosis is complex and often missed. Several institutions have engaged active chart review by a multidisciplinary clinical committee (MCC) - a highly labor intensive process - to identify patients at risk for CA. Objective: To assess whether the recently published RAISE score (Remodeling, Age, cardiac Injury, Systemic and Electrical abnormalities) could be a substitute to optimize the MCC based pre-screening process in a TAVI population. Methods: Our institutional MCC reviewed the medical chart of all patients who underwent TAVI in the past 3 years and appreciated the utility of scintigraphic screening. The decision to screen or not was based on the presence of red flags and the anticipated clinical benefice. The original RAISE score was slightly modified (mRAISE, Figure ) to facilitate its use in our TAVI patients, for whom CA suspicion had never been raised. A patient with a score ≥3 was considered at high risk for CA (best cutoff previously published). The mRAISE score was compared to the MCC’s decision using a Cohen’s k. Results: Among 239 included patients (79±7y, 55% male), an mRAISE score ≥3 was found in 47 (20%), of whom the MCC suggested screening to only 25 (53% agreement), most of the remaining 22 being asymptomatic following TAVI. Of 192 patients (79%) with an mRAISE score &lt;3, the MDC decided on “no screening” for 180 (94% agreement) and “screening” for the other 12; 3 patients refused and 9 had a negative screening. When compared with the MCC’s decision, global agreement of the mRAISE score was 86% with k=0.52 ( Figure ). Conclusions: The mRAISE score is not a perfect substitute for a MCC but rather an ideal pre-screening tool to optimize efficiency. If calculated prior to MCC meetings, an mRAISE score &lt;3 can dramatically reduce the number of medical charts that need extensive review (&gt;3/4 in our cohort).
Abstract 13994: Time to Treatment and Efficacy of IL-1 Blockade With Anakinra in ST-Segment Elevation Myocardial Infarction
Authors: Marco Giuseppe Del Buono, Juan Ignacio Damonte, juan guido chiabrando, ROSHANAK MARKLEY, Jeremy Turlington, Cory R TRANKLE, Francesco Moroni, Le Kang, Charlotte Roberts, Hem Bhardwaj, Michael C Kontos, Giuseppe G Biondi-Zoccai, Benjamin W Van Tassell, Antonio Abbate
Journal: Circulation (2022)

Introduction: Interleukin-1 (IL-1) blockade with anakinra given within 12 hours from reperfusion has recently showed to reduce the inflammatory response as well as prevent heart failure (HF) events in patients with STEMI. Hypothesis: The aim of this study was to determine whether time to anakinra treatment influences the efficacy on systemic inflammation and HF events in patients with STEMI. Methods: This is a secondary analysis of the data from the three VCUART clinical trials, including adult patients with STEMI presenting within 12 hours of pain onset, enrolled within 12 hours of reperfusion and randomly assigned to anakinra or placebo for 14 days. We divided the cohort in two groups based on the median time from percutaneous coronary intervention (PCI) to investigational drug, and analyzed the effects of anakinra on the area-under-the-curve for C reactive protein (AUC-CRP) and on incidence of the composite endpoint of death or new onset HF. Results: We analyzed data from 139 patients: 84 (60%) treated with anakinra and 55 (40%) with placebo. The median time from PCI to investigational treatment was 271 [182-391] minutes. The AUC-CRP was significantly higher in patients receiving placebo versus anakinra both in those with from PCI to treatment &lt;271 min (222.6 [103.9-325.2] vs 78.4 [44.3-131.2], p&lt;0.001) and those with time from PCI to drug ≥271 min (235.2 [131.4-603.4] vs 75.5 [38.9-171.9, p&lt;0.001]. Anakinra significantly reduced the combined endpoint of death or new onset HF in patients with time from PCI to treatment &lt;271 min (5 [11%] vs 9 [36%], log-rank p value=0.014) as well as in patients with time from PCI to drug ≥271 min (2 [5%] vs 7 [23%], log-rank p value= 0.046). Conclusions: In patients with STEMI treated with anakinra within 12 hours of reperfusion, the therapeutic window of IL-1 blockade on the systemic inflammatory response and on HF events in reperfused STEMI appears to be stable for several hours.
Abstract 13845: Atrial Fibrillation in Patients With Biopsy-Proven Cardiac Al Amyloidosis; A Cancer Center Experience
Authors: Charles Wanna, Christopher Black, Adam Niku, Juhee Song, Mariya Fatakdawala, Akshitha Yarrabothula, Jorge Irizarry-Caro, Chase Miller, Syed W Yusuf, Nicolas L Palaskas, Cezar Iliescu, Jean-Bernard Durand, Elie Mouhayar, Jose Banchs, Kaveh Karimzad, Anita M Deswal, Efstratios Koutroumpakis
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) is common in cardiac amyloidosis and often symptomatic. Commonly used therapeutics may be poorly tolerated. Patients with cardiac AL amyloidosis carry a high risk of stroke and bleeding, making anticoagulation challenging. This study examined the incidence of AF, treatment patterns, and incidence of thrombotic or bleeding complications. Methods: Patients with endomyocardial biopsy-proven cardiac AL amyloidosis treated at a tertiary cancer center between 6/2011 and 6/2020 were identified. Demographic and clinical data were abstracted. Outcomes included the development of AF, stroke and bleeding. Severe bleeding was defined as intracranial bleeding, hemorrhagic pericardial tamponade, or bleeding requiring endoscopic investigation. Results: Out of 43 patients with cardiac AL amyloidosis, 51% were diagnosed with AF during the follow up period (median 4.2 years (95% CI, 2.8-8.6)). Of those, 41% were women and 73% were white. Median age was 65.5 years (61-70). No significant demographic differences were identified between patients with and without AF. Beta-blockers were initiated in 86% and continued for more than 3 months in 59% of patients. Amiodarone was initiated in 50% and continued for more than 3 months in 18%. Treatment with digoxin and diltiazem were less common (27% and 14%, respectively). Pulmonary vein isolation was performed in 14% of patients. Anticoagulation (AC) was used in 59% of patients with AF and 19% of patients without AF for a different indication. Bleeding was common; 23% of AF patients reported an episode of severe bleeding, 60% of whom were on AC, in comparison to 19% in patients without AF, 50% of whom were on AC. Stroke was diagnosed in 14% of patients with AF, 67% of whom received AC, compared to 14% of patients without AF, 33% of whom received AC. Conclusions: Although AF is common (51%) in patients with cardiac AL amyloidosis, treatment with rate or rhythm control strategies is challenging. Many patients do not tolerate treatment for more than 3 months. While a significant number did not receive AC, there was a substantial risk of severe bleeding (1/4) and stroke (1/7). Given improved survival with newer therapies for AL amyloidosis, a greater focus on improving management of AF and outcomes is needed.
Abstract 13667: Coronary Artery Calcium for the Prediction of All-Cause and Cause-Specific Mortality Among Individuals With Obesity: The Coronary Artery Calcium Consortium
Authors: Ellen Boakye, Zeina A Dardari, John Erhabor, Albert Osei, Olufunmilayo Obisesan, Kunal Jha, Sant J Kumar, Alan Rosanski, Daniel S Berman, Matthew Budoff, Michael D Miedema, Khurram Nasir, John A Rumberger, Leslee J Shaw, Michael J Blaha
Journal: Circulation (2022)

Introduction: New therapies for obesity point to the need for greater risk stratification in this population. While the role of coronary artery calcium (CAC) for ASCVD risk prediction among key subgroups, e.g., those with intermediate ASCVD risk, is well established, the effectiveness of CAC for risk stratification in obesity, in which imaging is limited due to reduced signal-to-noise ratio, has not been well studied. Methods: We used data from 9,334 men and women (mean age 53.3 ± 9.7 years; 32.1% women) with BMI ≥30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior CVD history referred for CAC scan. We categorized CAC as absent/present and 0, 1-99, 100-299, ≥300 AU. We then evaluated the predictive value of CAC for all-cause and cause-specific mortality (cardiovascular and CHD) using multivariable-adjusted Cox proportional hazard and competing risks regression, respectively. Results: Of the 9,334 participants, 5,461 (58.5%) had CAC. Compared to persons without CAC, those with CAC &gt;0 had higher incidence of all-cause (5.65 vs 1.97 per 1,000 person-years), cardiovascular (1.89 vs 0.43 per 1,000 person-years), and CHD mortality (1.04 vs 0.19 per 1,000 person-years), after a mean follow-up of 10.8 ± 3.0 years. After adjusting for age, sex, and cardiovascular risk factors, individuals with CAC &gt; 0 had significantly higher risk of all-cause (HR 1.39; 95%CI 1.07 - 1.80), cardiovascular (SHR 2.06; 95%CI 1.20 - 3.54), and CHD mortality (SHR 2.72; 95%CI 1.21 - 6.14), compared to those without CAC. Of note, CAC ≥300 was associated with a markedly higher risk of all-cause, cardiovascular, and CHD mortality, even when restricting to persons with ≥ Class II obesity (≥35 kg/m2) (Table) Conclusions: Among individuals with obesity, CAC strongly predicts all-cause, cardiovascular, and CHD mortality and may therefore serve as an effective risk stratification tool to prioritize the allocation of therapies for weight management in this population.
Abstract 13800: Five-Year All-Cause Mortality in the Contemporary Coronary Artery Disease Patients Who Would Be Eligible for ISCHEMIA Trial
Authors: Miodrag C Ostojic, Natalija Arnautovic, Dusko Nezic, Tatjana Ragus, Petar Otasevic, Nebojsa Tasic, Aleksandra Nikolic, Bojan Stanetic, slobodan micovic, Tamara Preradovic, Dragana Unic Stojanovic, Stefan Veljkovic, Vladimir Mihajlovic, Luka Cucic, Milan Milojevic, Dragoljub Djokic, Snezana Boric, Milovan Bojic
Journal: Circulation (2022)

Introduction: Landmark ISCHEMIA (ISCH) trial provided unique information, but the generalizability of its results into myocardial revascularization guidelines and practice has been met by unprecedented debate. Hypothesis: We aimed to compare the 5 year all-cause mortality (5y Mt) in our ISCH trial like patients (pts) with results in ISCH. Methods: After applying ISCH study inclusion/exclusion criteria we identified 854 pts from our prospective database of 2455 consecutive pts who had the first isolated CABG in 2012-2015 with complex CAD with 100% follow up (F-up) of 5y Mt. Results: Comparative characteristics of ISCH like and actual ISCH pts are presented in Table 1. Аll our pts underwent CABG, contrary to ISCH where CABG and PCI were used in 538 and 1532 pts, consecutively. Although in ISCH pts had high diversity of ethnicity, were older, had more DM2 (but less insulin dependent), and had previous PCI or CABG in 25%, our pts were strikingly sicker (lower LVEF, higher proportion of 3VD and proximal LAD, higher NYHA as well as more comorbidities) 5-year mortality was 8.9% compared to 9% in the Invasive arm of ISCH. Of note 48 h mortality from MI type 5 (post CABG) was 1.67% in ISCH, and 30-day Mt in our study was 1.30%, with complete revascularization in 95%. As expected by the disease severity treated by CABG early Mt was higher in our than ISCH pts (Figure 1). Conclusion: The present study findings outline that translation of results from the ISCHEMIA trial with practice-changing implications into recommendations for a local Heart Team discussion to advise the best treatment decision for patients with more complex forms of CAD is uncertain and requires further research activities.
Abstract 13931: Comparison of Inpatient Outcomes of Transcatheter Aortic Valve Replacement in Bicuspid versus Tricuspid Aortic Valve Stenosis: An Insight From National Inpatient Sample
Authors: Abhushan Poudyal, Dae Yong Park, Smriti Khanal, Prajwal Shrestha, Bharosa Sharma, Sadichhya Karki, Aviral Vij
Journal: Circulation (2022)

Background: TAVR is increasingly performed in patients with severe aortic stenosis (AS), including those with bicuspid aortic valve (BAV). There is a paucity of data on the safety and efficacy of TAVR in the latter group since they were excluded from the landmark trials which established TAVR as a favorable alternative to surgery. Prior studies have shown higher rates of permanent pacemaker placement (PPM) and paravalvular leak (PL) but comparable rates of embolic stroke (ES) and mortality in BAV patients who underwent TAVR when compared to those with tricuspid aortic valve (TAV). We examined the impact of aortic valve anatomy on inpatient mortality and complication rates using current data from the largest inpatient database in the United States.Methods:We queried the 2016-2019 National Inpatient Sample database to identify all patients over 18 years of age who underwent TAVR for AS. Patients were stratified to BAV and TAV groups using ICD-10 codes. Greedy nearest neighbor propensity score matching was performed based on demographics, Charlson comorbidity index, hospital characteristics, insurance status, and median income. Outcomes of interest included rates of mortality, PPM, PL, ES, and length of hospital stay (LOS).Results:Of 192,100 AS patients who underwent TAVR, 0.5% had BAV. After propensity score matching, 995 BAV and 995 TAV patients were included in the final analysis. The overall mortality rate was 1.5% with no significant difference between the two groups [OR 1.00 (0.20-5.060), p=1.00]. Rates of PPM were 10.1% in BAV and 8.5% in TAV patients with no significant difference [OR 1.20 (0.61-2.37), p=0.61]. Rates of PL were 1% in BAV and 0.5% in TAV patients with no significant difference [OR 2.01 (0.18-22.65), p=0.57]. Rate of ES was 1.5% in BAV patients; however, direct comparison to its propensity-matched TAV cohort was not feasible since the latter group had no events in this analysis. There was no significant difference in the LOS between the two groups.Conclusion:Insight from this large database suggests that in the current era, TAVR has similar short-term outcomes in both BAV and TAV patients. Further studies with long-term follow-up on valve function and the need for reintervention will be needed, especially since this involves younger patients.